Cognitive Approach to treating Depression

Question 1

Cognitive Behavioural Therapy

Answer 1

• Most commonly used psychological treatment for depression.
• Includes cognitive and behavioural elements for treatment.

Question 2

Cognitive Element to CBT

Answer 2

• Starts with assessment where problems are clarified.
• Therapist and client jointly identify goals and a plan.
• Central task: identify negative or irrational thoughts that benefit from challenge.

Question 3

Behaviour Element to CBT

Answer 3

• Work to change negative or irrational thoughts.
• Put effective behaviours in place.

Question 4

Beck’s Cognitive Therapy

Answer 4

• Cognitive therapy is the application of Beck’s cognitive theory of depression.
• Goal of cognitive therapy: identify automatic thoughts about the negative triad.
• Once identified, these thoughts must be challenged.
• Cognitive therapy helps clients test reality of their negative beliefs.
• Client prep or ‘client as a scientist’ record when they enjoyed an event or when people are nice.

Question 5

Elli’s Rational Emotive Behaviour Therapy (REBT)

Answer 5

• REBT extends the ABC model to ABCDE
• D = dispute
• E = effect
• Central technique for REBT: identify and challenge irrational thoughts.
• Ex: client feels unlucky or unfairness in life. REBT therapist classifies this as utopianism and challenges irrational belief.
• Vigorous argument works to change irrational belief and break link between life event and depression.
• Vigorous argument is hallmark of REBT.
• Different methods of disputing:
• Empirical: disputing if there is actual evidence to support negative belief.
• Logical: disputing if negative thought logically follows from facts.

Question 6

Behavioural Activation

Answer 6

• Depressed people avoid difficult situations and become isolated. This maintains or worsens symptoms.
• Behavioural activation: work with depressed people to gradually decrease avoidance and isolation, increase engagement in activities that improve mood (exercising, socializing, etc).
• Therapist reinforces these activities.

Question 7

Evaluation

Evidence for effectiveness

Answer 7

Evidence for effectiveness
- Strength: plenty of evidence to support its effectiveness for treating depression.
- March et al. (2007): compared CBT to antidepressants and combo of both with 327 depressed adolescents.
- Significant improvement after 36 weeks for:
* 81% of CBT group.
* 81% for antidepressant group.
* 86% of CBT and antidepressants group.

Question 8

Evaluation suy

Answer 8

Suitability for Diverse Clients
- Limitation: lack of effectiveness for severe cases of clients with learning disabilities.
- Depression may be so severe client isn’t motivated to engage with CBT.
- Sturmey (2005): any form of psychotherapy is not suitable for people with learning disabilities.
- CBT only appropriate for specific range of depressed people.

Question 9

Suitability Counterpoint evaluation

Answer 9

Suitability Counterpoint
- Review by Lewis and Lewis (2016): CBT as effective as antidepressant drugs and behaviour therapies for severe depression.
- Review by Taylor et al. (2008): when used appropriately, CBT effective for those with learning disabilities.
- Is CBT suitable to a wider range of people than previously thought.

Question 10

evualtion rate

Answer 10

Relapse Rates
- Limitation of CBT: high relapse rates
- CBT effective in tackling symptoms, but how long do benefits last?
- Ali et al. (2017): assessed depression in 439 clients every month for 12 months following course of CBT.
- Result: 42% of clients relapsed within 6 months of treatment. 53% relapsed within a year.
- CBT may need to be repeated periodically.

Question 11

eval cline

Answer 11

Client Preference
- CBT identifies and changes unhelpful patterns of thinking and behaviour, but not all clients want to tackle depression this way.
- Some want symptoms gone as fast as possible, others want to explore origins of symptoms.
- Yrondi et al. (2015): depressed people rated CBT as least preferred psychological theory.